A-1 Internet Service Provider
Customer Application
This form must be completed in full
before the activation of any services.
| 3 letter Customer ID ______ P/W_____________ |
Application Date _________ |
| Company Name |
____________________________________ |
| Address |
____________________________________ |
| Address |
____________________________________ |
| City |
____________________ State _____ Zip ________ |
Contact # 1
(Overall account administration, information, technical support, etc.)
| Name |
__________________________ |
Title |
________________________ |
| Email Address |
_______________________ |
Signature |
________________________ |
| Contact Phone |
___________________ |
Contact Fax |
___________________ |
Contact # 2
(Contact for Accounts Payable)
| Name |
__________________________ |
Title |
________________________ |
| Email Address |
_______________________ |
Signature |
________________________ |
| Contact Phone |
___________________ |
Contact Fax |
___________________ |
| Note to Customers: |
Persons not appearing on this form will not
be allowed contact with A-1 ISP regarding this account. A-1 ISP maintains
strict account security. Therefore, the person whom ISP desires to have
contact with A-1 ISP Personnel should be added to this form. |
A-1 ISP Internal Use
| Account User name |
________________ |
| Account Password |
________________ |
| Activation Date |
________________ |
| Created By |
________________ |
|
The A-1 ISP Account User name is used for
deposit and management of all A-1 ISP Customer Services. This will be used
in conjunction with all customer contact. This user name and password issued
is also used to access the online A-1 ISP Reseller Backroom. |
ALL A-1 ISP SERVICES ARE HELD TO THE A-1 ISP TERMS
OF SERVICE DOCUMENT AND THE A-1 ISP AGREEMENT
Post Office Box 1333, El Cajon, CA 92022
(877)442-1477 Voice
www.a1wholesale.net sales@a1wholesale.net
|